Hello, My Name Is …Hello, My Name Is …((What’s in a name?What’s in a name?))

• Carlos Alfonso Gonzalez Castro• Sonia Salazar del Castillo• Sonia Salazar de Gonzalez• Carlos Javier Gonzalez Salazar

• Dilip Natwarlal Pandya• Mangala Dilip Pandya• Sapna Dilip Pandya

• Zhang Wen Yi (last name/first name)• In the U.S. may become Wen-Yi Zhang• “Wendy Chang”

Who are we?Who are we?

BrainstormBrainstorm

• What are generalizations?

• What are stereotypes?

• What is cultural competence?

Why & How do we do this?

Where is this person from and why?Where is this person from and why?

Generalizations Generalizations vs. vs.

StereotypesStereotypes

Stereotyping: A DefinitionStereotyping: A Definition

• The process by which people use social categories (e.g. race, sex) in acquiring, processing, and recalling information about others.

Generalization: A DefinitionGeneralization: A Definition

A statement or judgment made based on common trends or occurrences that may be seen in several individuals and then those presumptions are applied to the entire group.  

Be Careful to Avoid StereotypingBe Careful to Avoid Stereotyping

• While there are similarities among people from the same culture, each individual has a unique personal history, belief system, communication style, and health status.

CULTURAL COMPETENCECULTURAL COMPETENCE

CULTURCULTUR(e)(e)AL COMPETENCEAL COMPETENCE

• What does it mean?

• Why does it matter?

• How do we become culturally competent?

Title VI of the Civil Rights Act of 1964Title VI of the Civil Rights Act of 1964

No person shall "on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance."

What is culture?What is culture?

The learned and shared patterns of information that a group uses to generate meaning among its members.

Macro cultures:

national, ethnic or racial groups

Micro cultures:

sexual orientation, disability, religion, gender, age …what else ??

Example: Example: Understanding Religion & Faith to Care Understanding Religion & Faith to Care

Effectively for PatientsEffectively for Patients

• Dietary laws of different faiths/people– vegetarianism, Kosher, Halal, hot/cold foods

• San Gregorio, other “faith healers” • Clothing & modesty• After death:

– Cremation, ritual washings, burial• Fatalism• Observance of holidays may influence care

– Ramadan, Sabbath

BARRIERS TO ACCESSING CAREBARRIERS TO ACCESSING CARE

BARRIERS TO ACCESSING CAREBARRIERS TO ACCESSING CARE

FIN

AN

CIA

LLINGUISTIC

GEOGRAPHIC

LEG

AL

SOCIO-C

ULTURAL

Example: Example: How does one get a “Green Card”?How does one get a “Green Card”?

• Through a family member

• Through employment

• Through marriage

• Diversity lottery

• Through Investment

• Adjustment of Refugee/Asylee status

• Others, e.g. Violence Against Women Act, International adoption

Immigrant ConcernsImmigrant Concerns

• Financial Security (employment and shelter)

• Adjustment of Status (public charge)

• Immigration Status (confidentiality, fear of deportation)

• Family (sponsorship and support)

• Health

Professionalize the Ad Hoc…Professionalize the Ad Hoc…

• Confidentiality• Interpretation must be ‘accurate’

No omissionsNo additionsNo substitutionsNo glossing over (mental health)No editorializingRendering tone Asking for clarification

Get to know the Get to know the individualindividual

• How do you prefer to be addressed? • What country did you grow up in?• How did you travel here today?• Are you comfortable reading?• Are you more comfortable reading information in

[your native language] or in English?• Tell me about how important healthcare

decisions are made in your family…• Are there certain health care procedures and

tests which your culture prohibits?

For your program’s considerationFor your program’s consideration

• What populations are predominantly represented in your program?

• What are the needs, values, beliefs, traditional concepts particular to these groups?

• Who are the “gatekeepers” of health within these groups?

• What is the group’s perception of health and illness?

• What is the relationship between health care providers and the community?

Improving Cultural Competence Improving Cultural Competence at a Program Levelat a Program Level

• Assess cultural / linguistic competence• Train existing staff (general and specific)• Hire bi-cultural and bi-lingual staff to match your clients

• Manage a culturally diverse workplace• Use interpreters or interpretation service• Work with community based groups• Provide TB educational materials for different cultures/languages